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Med Surg: Ortho - Knee
Winter Semester - 2011
91
Medical
Graduate
01/27/2011

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Cards

Term
What is the important job of the quadriceps group?
Definition
Extends the knee, important stabilizer of knee during the gait
Term
What is the job of the hamstring group?
Definition
Flexes the knee, arrests knee extension during the gait
Term
What is genu valgum?
Definition
tibia (distal knee) goes away from midline ("knocked knee")
Term
What is genu varus?
Definition
tibia (distal knee) goes towards midline ("bowed leg")
Term
What are the flexors (hamstrings) innervated by?
Definition
Sciatic n.
Term
What are the extensors (quadriceps) innervated by?
Definition
Femoral n.
Term
What is the ACL responsible for?
Definition
Responsible for limiting forward translation of the tibia and prevents hyperextension
Term
What is the MOI (Mechanism of Injury)?
Definition
Planted foot with twisting motion of body
Term
If a pt presents with pain in the knee, hemarthrosis, hx of a "POP" with trauma, and on physical exam there is a + Lachman's test, what condition should you suspect?
Definition
ACL tear
Term
What is the appropriate work-up for an ACL tear?
Definition
Eval for other injuries (PCL, Meniscal, CL)
Exam
MRI
Arthrocentesis (If hemarthrosis present)
Term
What are the causes of a chronic ACL tear?
Definition
Missed dx
Failed non-operative treatment
Term
What are the complications of a chronic ACL tear?
Definition
Increased knee instability/laxity
Meniscal tears
Term
What is the positioning of the ACL in the knee joint?
Definition
Connects the posterior femur to the anterior tibia
Term
What is the BEST physical exam test for an ACL tear?
Definition
Lachman’s Test
Term
Which ACL test is described as Pt supine, w/ knee flexed at 30 degrees, Femur stabilized w/ one hand and tibia is pulled anterior w/ the other hand?
Definition
Lachman's Test
Term
Which ACL stability test is described as Pt supine, hip flexed, knee flexed at 45 degrees, Pt foot stabilized by examiner sitting on foot, Examiner “pulls” tibia forward/anterior?
Definition
Anterior Drawer Test
Term
What is the treatment for an ACL tear?
Definition
Surgical Repair and PT
Term
Which injury is more common, ACL tear or PCL tear?
Definition
ACL tear
Term
Why is a PCL injury much less common than an ACL tear?
Definition
Much stronger than ACL
Other structures aid in the PCLs function
Term
What is the MOI for a PCL?
Definition
MOI usually direct force if isolated injury
Term
If you have a PCL tear, what other conditions should you suspect?
Definition
ACL, CL (Knee Dislocation)
Term
If a pt presents with knee pain, history of direct knee injury, an on exam you observe a posteriorly subluxed resting tibia, what condition should you suspect?
Definition
PCL Tear
Term
What is the treatment for a isolated PCL?
Definition
Non-operative treatment
Term
When does an PCL tear get surgically corrected?
Definition
With COMPLETE Knee dislocation
Term
What knee stability test is described as Pt supine, hip flexed, knee flexed at 45 degrees, Pt foot stabilized by examiner sitting on foot, Examiner “pushes” tibia posterior?
Definition
Posterior Drawer Test
Term
What type of stress does the MCL resist against?
Definition
Medical or Valgus stress
Term
What type of stress does the LCL resist against?
Definition
Lateral or Vargus stress
Term
If a pt presents with pain along the medial joint line of the knee and pain with valgus stress, what condition should you suspect?
Definition
MCL injury
Term
What imaging should be used for knee ligament injuries?
Definition
MRI
Term
Which physical exam tests should be used to evaluate a MCL injury?
Definition
Valgus Stress Test
Apley's Distraction Test
Term
What nerve can be injured with a LCL tear?
Definition
Peroneal n.
Term
What is the treatment for a MCL tear?
Definition
nonsurgical therapy
Term
What is the MC ligament that is injured in the body?
Definition
MCL
Term
A LCL tear is not usually an isolated injury, what injury is usually associated with it?
Definition
Usually associated with cruciate and posteriorlateral corner injury
Term
Which physical diagnosis test is used to evaluate an LCL tear?
Definition
Varus Stress Test
Apley's Apprehension test
Term
Which physical diagnosis test is described as Pt supine on the table, leg abducted, Examiner applies force in the lateral direction to the ankle from the medial aspect and force in the medial direction of the knee from the lateral aspect?
Definition
Valgus Stress Test
Term
Which physical diagnosis test is described as Pt supine on the table, leg abducted, Examiner applies force in the medial direction to the ankle from the lateral aspect and force in the lateral direction of the knee from the medial aspect?
Definition
Varus Stress Test
Term
What does a MCL or LCL injury usually result in?
Definition
Usually results in significant stiffness or residual instability
Term
Which part of the Meniscus is the MC to be injured?
Definition
Medial injuries more frequent than lateral injuries
Term
What is the MOI for Meniscal Tears?
Definition
twisting injury
Term
If a pt presents with knee pain, popping, locking or giving way, and on physical exam there is joint line tenderness, a positive McMurray's test and and a positive Apley's compression test, what condition should you suspect?
Definition
Meniscal Injury
Term
What is the BEST diagnostic test for Meniscal Injuries?
Definition
MRI
Term
Which physical diagnosis is described as Pt lies supine w/ knee completely flexed (foot to buttocks), Examiner medially (internally) rotates foot and tibia, and extend leg/knee?
Definition
McMurray Test – lateral meniscus
Term
Which physical diagnostic test is described as Pt lies supine w/ knee completely flexed (foot to buttocks), Examiner laterally (externally) rotates foot and tibia, and extend leg/knee?
Definition
McMurray Test – medial meniscus
Term
Which physical diagnostic test is described as Pt in prone position, knee flexed to 90 degrees, Examiner applies pressure to (pushes on) the heel and then medial and laterally rotates the leg/foot?
Definition
Apley’s compression test
Term
If the patient has a + Apley's on the medial side, where is the Meniscal tear?
Definition
Medial Meniscal injury
Term
If the patient has a + Apley's on the lateral side, where is the Meniscal tear?
Definition
Lateral Menisicus
Term
What condition is caused by extrusion of synovial fluid through the meniscal tear, accumulating outside the joint capsule?
Definition
Meniscal Cysts
Term
What imaging is appropriate for meniscal cysts?
Definition
MRI
Term
If a pt presents with a mass on the lateral side of their knee that changes size with flexion and extension, and their is a PHx of trauma, what condition should you suspect?
Definition
Meniscal Cyst
Term
What is the treatment of a Meniscal cyst?
Definition
Excision/Drainage and repair or removal of meniscus
Term
What is the treatment for Bursitis?
Definition
Ice, Compression, Crutches, NSAIDs
Aspiration (helps in pain) or Injection
Term
What are the signs and symptoms of bursitis?
Definition
pain and swelling over bursa
Term
Which bursas are MC affected in the knee with bursitis?
Definition
Suprapatellar bursa
Subcutaneous prepatellar bursa
Term
Does bursitis have pain with ROM? Why is this important?
Definition
No; Differentiates it from septic arthritis b/c with septic arthritis there will be pain with ROM
Term
What is a Baker's cyst?
Definition
A bursitis of the semimembranosus bursa that develops calcifications
Term
If there is prepatellar busitis, what should you suspect?
Definition
Infection (until proven otherwise)
Term
What should you be highly concerned about with femur shaft fractures? What should you do to prevent this concern?
Definition
hemovascular compromise; Stabilization Device (splint, screw etc)
Term
What is the MOI for femur shaft fracture?
Definition
high energy trauma - MVA, Gunshot wounds, falls from heights
Term
What is the imaging tool that is used to diagnose a femur shaft fracture?
Definition
Plain Film
Term
What is the treatment for femur shaft fracture?
Definition
hemovascular stabilization (Type and cross match)
Stabilization device
Ortho
Term
What is the biggest concern with tibial plateau fractures? How can you prophylactically address these concerns?
Definition
Compartment syndrome; faciaotomy (spelling?)
Term
What is the treatment for tibial plateau fracture?
Definition
Surgery
Term
What is used to classify a tibial plateau fracture?
Definition
Schatzker (1 - 6 the higher the # the more difficult the surgical repair)
Term
What imaging is needed for a tibial plateau fracture?
Definition
Plain film and MUST get CT w/scout views
Term
What is the MOI for a tibial plateau fracture?
Definition
falls from heights, MVA accidents and MVA/pedestrian accident
Term
What does a small avulsion fracture of the lateral ligament indicate?
Definition
Usually signals a severe joint injury (LCL and ACL)
Term
What is the MOI of a patellar fracture?
Definition
fall or MVA
Term
If a pt presents with complaints of trauma, acute knee pain, swelling and an inability to extend the knee, what condition should you suspect?
Definition
Patellar fracture
Term
What imaging should be done to assess a patellar fracture?
Definition
Plain film
Term
What is the treatment for a patellar fracture?
Definition
Surgery!! (Seen John for the Steel Cable)
Term
What are the risk factors for a patellar dislocation?
Definition
excessive Q angle, ligament laxity, Pes Planus
Term
Which physical diagnosis test is described as Pt supine, legs flat on table, quadriceps relaxed, Try to dislocate the patella laterally?
Definition
Patellar Apprehension Test
Term
What is the treatment for a patellar dislocation?
Definition
Reduction (Grab big toe)
Ortho consult (Disrupts the patellar femoral retinaculum)
NSAIDs/Pain Meds
Term
What is the treatment for Tibiofemoral dislocation?
Definition
Ortho and Vascular surgery Emergency (literally 1 hr before limb death occurs)
Term
What are the imaging studies needed for a tibiofemoral dislocation?
Definition
Plain film
ARTERIOGRAM!
Term
If a pt presents with a severe knee deformity s/p MVA and pulselessness in the ankle, what condition should you suspect?
Definition
KNEE DISLOCATION (ER!!!)
Term
If the pt presents s/p injury to their knee w/ acute pain and swelling and inability to extend knee, and on physical exam the patella is located proximally over femur head ("riding up"), what condition should you suspect?
Definition
Patellar tendon rupture
Term
What is the treatment for patellar tendon rupture?
Definition
Ortho - surgery
Term
If a pt presents with knee pain and stiffness and decreased ROM, what condition should you suspect?
Definition
Osteoarthritis
Term
What is the treatment for osteoarthritis?
Definition
PT consult – ROM
Decrease weight
NSAIDS
Ortho – knee replacement
Term
What is the cause of Patellofemoral Syndrome
(Chondromalacia)?
Definition
overuse or excessive Q angle
Term
If a pt presents with Anterior knee pain worse w/ stair climbing or prolong sitting, and on physical exam you note + patellar tenderness & swelling and + apprehensive test, what condition should you suspect?
Definition
Patellofemoral Syndrome
(Chondromalacia)
Term
What is the treatment for Patellofemoral Syndrome
(Chondromalacia)?
Definition
PT consult
R.I.C.E & NSAIDS
Ortho consult if needed – diagnose chondromalacia
Term
If there is a knee effusion, what MUST you do diagnostically?
Definition
TAP IT!!
Term
What are the WBC levels for an inflammatory effusion?
Definition
2000-80000
Term
What are the WBC levels for an septic effusion?
Definition
>80000
Term
What is the neutrophil % in an inflammatory effusion?
Definition
25-75%
Term
What is the neutrophil % in a septic effusion?
Definition
>75%
Term
What is the general protein/glucose ratio in septic effusion?
Definition
Septic high protein/low glucose
Term
What physical diagnosis test is described as Pt supine, examiner pushes fluid from the suprapatellar pouch toward the foot (“milking the knee”)?
Definition
Minor effusion test/Patellar Ballotment
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